GENERAL/MIX
What is the benefit year for BX?
July 1- June 30
Is there a form to commence this BX?
No, or at registry
What is the form code for NGBX Application?
Where else are they found?
AHC0201
Registry office or sent via mail
Who is Palliative coverage for?
Persons diagnosed by a health practioner/nurse as palliative (people living with serious illness last stage of life)
BX will mimic what account?
AHCIP
Who manages and who are the ones who administer these supplementary coverages?
AB Health & AB BX
Coverage for Seniors takes effect when?
The first of the month after their 65th birthday or o If the 65th birthday falls on the first of the month, Coverage for Seniors will commence on the same day
Is there an annual deductible for NGBX? with the exception of what?
$50, exception, prescriptions, hospital services and diabetic supplies
Where can they find the application, who can send it for them?
You can get the application form from:
Can a married couple separate their account?
No, only common law partners
WHO DECIDES WHICH MEDICATION WILL BE INCLUDED ON DBL/DRUG BENEFIT LIST?
AB Health Pharmacy.
Examples of acceptable proof of age documents are?
Birth Certificate o Baptismal Certificate o Passport or Immigration Record o Canadian Citizenship card/certificate o Canadian driver’s license or identification (ID) card o Old Age Entitlement Form o Proof of Age Declaration, verified by a Commissioner for Oath
Robert was recently released from the Canadian Armed Forces on 20240214 he is applying for NGBX on 20240227 when is his effective date?
20240301
What is the prescription drug coverage?
100% no co-payment
What percentage does AB Heath pay for prescription drugs? How much does the patient pay? What is the max allowable payment?
70%
30%
$25
Can you use your BX OOP?
some OOP pharmacists are able to bill direct but most will collect payments upfront. Then clients can submit their claims to BX for assessment/reimbursements.
Can you be reimbursed for payments of NGBX?
How? and for how long retroactively?
seniors can get reimbursement for up to 24 months (ex. They are enrolled in NGBX and continue paying because they didn’t show proof of age) you don’t have to do anything in Reflections it will be adjusted once they showed proof of age
Jan calling on 20250110 she was a FT student but now is no longer studying she was deleted for E 20241130 she needs NGBX how would you advise her?
Confirm she is back in AB When? If yes reinstate on her own acct for 20241201, must send in application for NGBX effective for first day of the fourth month from when application is received.
How do you figure out their effective date for palliative coverage?
Call BS
What are the income levels for NGBX Subsidy?
Single less than $20,970
Family-no children $33,240
Family-with children $39,250
How would you help a caller regarding if their special authorization letter was approved?
Call Blue Cross Customer Service at 780-498-8000 or 1-800-661-6995 or explain that we usually send a letter of approval or denial to whoever requested or sent the Special Authorization form (can be their Dr. or them).
What is the start date for seniors who are new to Canada and AB?
First of the following month, or month they arrive if landed the 1st.
Jackson is calling regarding is NGBX he went to the pharmacy and was told it was no longer working, you see that he was recently divorced and moved to his own acct why is his card not working?
In the case where the Stat 1 and 2 are separating and Stat 2 is moving to their old account or a new one, check SSDIR to see who applied for the Non-group. If the Stat 2 applied for it, then we have an application on file and they can have Non-group added to new (or old) account. Because the invoices are sent to the Stat 1, that person will need to notify us if they no longer need it.
In the case where the Stat 2 did not sign the application, then we need them to complete an application within 30 days to have the coverage added so it’s continuous.
Please ensure a note of the conversation is placed on file. Also have the agent advise that the applicant must indicate they want continuous coverage as previous coverage cancelled when coming off ex’s account.
I am going to look into the option of allowing the spouse to provide a verbal consent to get Non-group added to their new/old account when they didn’t sign the application.
If the Stat 1 is a senior, then the Stat 2 has been responsible for the billing so if they separate then the Stat 2 should take the coverage with them when the move off the account.
Who can access their account regarding their palliative coverage application?
Where do you refer seniors in need of dental and optical benefits?
AB Supports Seniors Financial Assistance